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  • Therapeutic Phlebotomy Order Form

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120 Spalding Drive; Suite 111; Naperville, IL 60540 Phone: 630/527-3788 Fax: 630/548-6617 THERAPEUTIC PHLEBOTOMY ORDER FORM Patient Name: DOB: Pre-Authorization #: (Ordering Physician Office is Responsible.

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Therapeutic phlebotomy has several physiological mechanisms. For example, bone marrow stem cells are stimulated by bloodletting to generate new red blood cells (RBCs), which requires the transport of iron (in the ferritin form) from the body's stores to create hemoglobin (Hb).

Treatment Overview Health professionals perform phlebotomy in a medical clinic. The process is similar to donating blood. A health professional inserts a needle into a vein in your arm and removes about 500 mL (17 fl oz) of blood.

Hearing your physician recommend therapeutic phlebotomy (also known as bloodletting or venesection) might alarm you.

Therapeutic phlebotomy (blood removal) — Therapeutic phlebotomy entails periodic removal of blood. The process is very similar to donating blood (and involves removing about the same amount). The blood removed by therapeutic phlebotomy can be used to provide blood transfusions for other people.

You do not need to fast or make special preparations before phlebotomy. But try to eat a good meal and drink plenty of fluids before phlebotomy. This will prevent dizziness or fainting. Health professionals will have you sit or lie down.

Typically, therapeutic phlebotomy consists of (i) removal of 1 unit (450 to 500 ml) of blood weekly until the serum ferritin level is 10 to 20 ug/L, and (ii) maintenance of the serum ferritin level at 50 ug/L or less thereafter by periodic removal of blood.

What are the disadvantages? In general, therapeutic phlebotomy caries the same possible risks as with any blood donation such as nausea, vomiting, dizziness, fainting, hematoma (bruise from blood leaking under skin at needle puncture site), seizures or local infection.

Therapeutic phlebotomy is a blood draw procedure usually prescribed by a physician as part of a treatment of various medical conditions associated with accumulation of excess iron in the body. Common examples of such conditions are hemochromatosis, porphyrias and polycythemia.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232